Provider Demographics
NPI:1326598103
Name:BROUELETTE, HEIDI (MA LPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:BROUELETTE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34406 N 27TH DR BLDG 6
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6082
Mailing Address - Country:US
Mailing Address - Phone:480-677-9913
Mailing Address - Fax:623-223-1333
Practice Address - Street 1:34406 N 27TH DR BLDG 6
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6082
Practice Address - Country:US
Practice Address - Phone:480-677-9913
Practice Address - Fax:623-223-1333
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15257101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor